|
TRI TS FEMUR SZ 1 LEFT
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI TS FEMUR SZ 1 RIGHT
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI TS FEMUR SZ 1 RIGHT
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI TS FEMUR SZ 2 LEFT
|
Facility
|
OP
|
$33,843.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,153.05 |
| Max. Negotiated Rate |
$32,489.76 |
| Rate for Payer: Aetna Commercial |
$26,059.49
|
| Rate for Payer: Anthem Medicaid |
$11,638.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,397.93
|
| Rate for Payer: Cash Price |
$16,921.75
|
| Rate for Payer: Cigna Commercial |
$28,090.10
|
| Rate for Payer: First Health Commercial |
$32,151.33
|
| Rate for Payer: Humana Commercial |
$28,766.97
|
| Rate for Payer: Humana KY Medicaid |
$11,638.78
|
| Rate for Payer: Kentucky WC Medicaid |
$11,757.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,751.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,976.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,153.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,872.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,782.28
|
| Rate for Payer: Ohio Health Group HMO |
$25,382.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,074.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,443.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,352.01
|
| Rate for Payer: PHCS Commercial |
$32,489.76
|
| Rate for Payer: United Healthcare All Payer |
$29,782.28
|
|
|
TRI TS FEMUR SZ 2 LEFT
|
Facility
|
IP
|
$33,843.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,153.05 |
| Max. Negotiated Rate |
$32,489.76 |
| Rate for Payer: Aetna Commercial |
$26,059.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,397.93
|
| Rate for Payer: Cash Price |
$16,921.75
|
| Rate for Payer: Cigna Commercial |
$28,090.10
|
| Rate for Payer: First Health Commercial |
$32,151.33
|
| Rate for Payer: Humana Commercial |
$28,766.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,751.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,976.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,153.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,782.28
|
| Rate for Payer: Ohio Health Group HMO |
$25,382.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,074.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,443.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,352.01
|
| Rate for Payer: PHCS Commercial |
$32,489.76
|
| Rate for Payer: United Healthcare All Payer |
$29,782.28
|
|
|
TRI TS FEMUR SZ 2 RIGHT
|
Facility
|
IP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 2 RIGHT
|
Facility
|
OP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem Medicaid |
$11,077.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Humana KY Medicaid |
$11,077.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,190.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,299.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 3 LEFT
|
Facility
|
IP
|
$33,843.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,153.05 |
| Max. Negotiated Rate |
$32,489.76 |
| Rate for Payer: Aetna Commercial |
$26,059.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,397.93
|
| Rate for Payer: Cash Price |
$16,921.75
|
| Rate for Payer: Cigna Commercial |
$28,090.10
|
| Rate for Payer: First Health Commercial |
$32,151.33
|
| Rate for Payer: Humana Commercial |
$28,766.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,751.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,976.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,153.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,782.28
|
| Rate for Payer: Ohio Health Group HMO |
$25,382.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,074.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,443.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,352.01
|
| Rate for Payer: PHCS Commercial |
$32,489.76
|
| Rate for Payer: United Healthcare All Payer |
$29,782.28
|
|
|
TRI TS FEMUR SZ 3 LEFT
|
Facility
|
OP
|
$33,843.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,153.05 |
| Max. Negotiated Rate |
$32,489.76 |
| Rate for Payer: Aetna Commercial |
$26,059.49
|
| Rate for Payer: Anthem Medicaid |
$11,638.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,397.93
|
| Rate for Payer: Cash Price |
$16,921.75
|
| Rate for Payer: Cigna Commercial |
$28,090.10
|
| Rate for Payer: First Health Commercial |
$32,151.33
|
| Rate for Payer: Humana Commercial |
$28,766.97
|
| Rate for Payer: Humana KY Medicaid |
$11,638.78
|
| Rate for Payer: Kentucky WC Medicaid |
$11,757.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,751.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,976.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,153.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,872.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,782.28
|
| Rate for Payer: Ohio Health Group HMO |
$25,382.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,074.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,443.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,352.01
|
| Rate for Payer: PHCS Commercial |
$32,489.76
|
| Rate for Payer: United Healthcare All Payer |
$29,782.28
|
|
|
TRI TS FEMUR SZ 3 RIGHT
|
Facility
|
IP
|
$28,031.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,409.40 |
| Max. Negotiated Rate |
$26,910.09 |
| Rate for Payer: Aetna Commercial |
$21,584.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,864.45
|
| Rate for Payer: Cash Price |
$14,015.67
|
| Rate for Payer: Cigna Commercial |
$23,266.01
|
| Rate for Payer: First Health Commercial |
$26,629.77
|
| Rate for Payer: Humana Commercial |
$23,826.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,985.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,687.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,409.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,667.58
|
| Rate for Payer: Ohio Health Group HMO |
$21,023.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,425.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,341.62
|
| Rate for Payer: PHCS Commercial |
$26,910.09
|
| Rate for Payer: United Healthcare All Payer |
$24,667.58
|
|
|
TRI TS FEMUR SZ 3 RIGHT
|
Facility
|
OP
|
$28,031.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,409.40 |
| Max. Negotiated Rate |
$26,910.09 |
| Rate for Payer: Aetna Commercial |
$21,584.13
|
| Rate for Payer: Anthem Medicaid |
$9,639.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,864.45
|
| Rate for Payer: Cash Price |
$14,015.67
|
| Rate for Payer: Cigna Commercial |
$23,266.01
|
| Rate for Payer: First Health Commercial |
$26,629.77
|
| Rate for Payer: Humana Commercial |
$23,826.64
|
| Rate for Payer: Humana KY Medicaid |
$9,639.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9,738.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,985.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,687.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,409.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,833.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,667.58
|
| Rate for Payer: Ohio Health Group HMO |
$21,023.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,425.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,341.62
|
| Rate for Payer: PHCS Commercial |
$26,910.09
|
| Rate for Payer: United Healthcare All Payer |
$24,667.58
|
|
|
TRI TS FEMUR SZ 4 LEFT
|
Facility
|
IP
|
$28,031.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,409.40 |
| Max. Negotiated Rate |
$26,910.09 |
| Rate for Payer: Aetna Commercial |
$21,584.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,864.45
|
| Rate for Payer: Cash Price |
$14,015.67
|
| Rate for Payer: Cigna Commercial |
$23,266.01
|
| Rate for Payer: First Health Commercial |
$26,629.77
|
| Rate for Payer: Humana Commercial |
$23,826.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,985.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,687.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,409.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,667.58
|
| Rate for Payer: Ohio Health Group HMO |
$21,023.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,425.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,341.62
|
| Rate for Payer: PHCS Commercial |
$26,910.09
|
| Rate for Payer: United Healthcare All Payer |
$24,667.58
|
|
|
TRI TS FEMUR SZ 4 LEFT
|
Facility
|
OP
|
$28,031.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,409.40 |
| Max. Negotiated Rate |
$26,910.09 |
| Rate for Payer: Aetna Commercial |
$21,584.13
|
| Rate for Payer: Anthem Medicaid |
$9,639.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,864.45
|
| Rate for Payer: Cash Price |
$14,015.67
|
| Rate for Payer: Cigna Commercial |
$23,266.01
|
| Rate for Payer: First Health Commercial |
$26,629.77
|
| Rate for Payer: Humana Commercial |
$23,826.64
|
| Rate for Payer: Humana KY Medicaid |
$9,639.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9,738.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,985.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,687.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,409.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,833.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,667.58
|
| Rate for Payer: Ohio Health Group HMO |
$21,023.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,425.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,341.62
|
| Rate for Payer: PHCS Commercial |
$26,910.09
|
| Rate for Payer: United Healthcare All Payer |
$24,667.58
|
|
|
TRI TS FEMUR SZ 4 RIGHT
|
Facility
|
IP
|
$36,198.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,859.44 |
| Max. Negotiated Rate |
$34,750.20 |
| Rate for Payer: Aetna Commercial |
$27,872.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,234.53
|
| Rate for Payer: Cash Price |
$18,099.06
|
| Rate for Payer: Cigna Commercial |
$30,044.44
|
| Rate for Payer: First Health Commercial |
$34,388.21
|
| Rate for Payer: Humana Commercial |
$30,768.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,682.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,714.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,859.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,854.35
|
| Rate for Payer: Ohio Health Group HMO |
$27,148.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,958.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,492.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,976.70
|
| Rate for Payer: PHCS Commercial |
$34,750.20
|
| Rate for Payer: United Healthcare All Payer |
$31,854.35
|
|
|
TRI TS FEMUR SZ 4 RIGHT
|
Facility
|
OP
|
$36,198.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,859.44 |
| Max. Negotiated Rate |
$34,750.20 |
| Rate for Payer: Aetna Commercial |
$27,872.55
|
| Rate for Payer: Anthem Medicaid |
$12,448.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,234.53
|
| Rate for Payer: Cash Price |
$18,099.06
|
| Rate for Payer: Cigna Commercial |
$30,044.44
|
| Rate for Payer: First Health Commercial |
$34,388.21
|
| Rate for Payer: Humana Commercial |
$30,768.40
|
| Rate for Payer: Humana KY Medicaid |
$12,448.53
|
| Rate for Payer: Kentucky WC Medicaid |
$12,575.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,682.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,714.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,859.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,698.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,854.35
|
| Rate for Payer: Ohio Health Group HMO |
$27,148.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,958.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,492.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,976.70
|
| Rate for Payer: PHCS Commercial |
$34,750.20
|
| Rate for Payer: United Healthcare All Payer |
$31,854.35
|
|
|
TRI TS FEMUR SZ 5 LEFT
|
Facility
|
OP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem Medicaid |
$11,077.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Humana KY Medicaid |
$11,077.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,190.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,299.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 5 LEFT
|
Facility
|
IP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 5 RIGHT
|
Facility
|
OP
|
$36,198.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,859.44 |
| Max. Negotiated Rate |
$34,750.20 |
| Rate for Payer: Aetna Commercial |
$27,872.55
|
| Rate for Payer: Anthem Medicaid |
$12,448.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,234.53
|
| Rate for Payer: Cash Price |
$18,099.06
|
| Rate for Payer: Cigna Commercial |
$30,044.44
|
| Rate for Payer: First Health Commercial |
$34,388.21
|
| Rate for Payer: Humana Commercial |
$30,768.40
|
| Rate for Payer: Humana KY Medicaid |
$12,448.53
|
| Rate for Payer: Kentucky WC Medicaid |
$12,575.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,682.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,714.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,859.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,698.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,854.35
|
| Rate for Payer: Ohio Health Group HMO |
$27,148.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,958.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,492.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,976.70
|
| Rate for Payer: PHCS Commercial |
$34,750.20
|
| Rate for Payer: United Healthcare All Payer |
$31,854.35
|
|
|
TRI TS FEMUR SZ 5 RIGHT
|
Facility
|
IP
|
$36,198.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,859.44 |
| Max. Negotiated Rate |
$34,750.20 |
| Rate for Payer: Aetna Commercial |
$27,872.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,234.53
|
| Rate for Payer: Cash Price |
$18,099.06
|
| Rate for Payer: Cigna Commercial |
$30,044.44
|
| Rate for Payer: First Health Commercial |
$34,388.21
|
| Rate for Payer: Humana Commercial |
$30,768.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,682.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,714.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,859.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,854.35
|
| Rate for Payer: Ohio Health Group HMO |
$27,148.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,958.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,492.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,976.70
|
| Rate for Payer: PHCS Commercial |
$34,750.20
|
| Rate for Payer: United Healthcare All Payer |
$31,854.35
|
|
|
TRI TS FEMUR SZ 6 LEFT
|
Facility
|
IP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 6 LEFT
|
Facility
|
OP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem Medicaid |
$11,077.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Humana KY Medicaid |
$11,077.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,190.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,299.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 6 RIGHT
|
Facility
|
IP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 6 RIGHT
|
Facility
|
OP
|
$32,210.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,663.23 |
| Max. Negotiated Rate |
$30,922.32 |
| Rate for Payer: Aetna Commercial |
$24,802.28
|
| Rate for Payer: Anthem Medicaid |
$11,077.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,124.38
|
| Rate for Payer: Cash Price |
$16,105.38
|
| Rate for Payer: Cigna Commercial |
$26,734.92
|
| Rate for Payer: First Health Commercial |
$30,600.21
|
| Rate for Payer: Humana Commercial |
$27,379.14
|
| Rate for Payer: Humana KY Medicaid |
$11,077.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11,190.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,412.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,771.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,663.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,299.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,345.46
|
| Rate for Payer: Ohio Health Group HMO |
$24,158.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,768.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,023.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,225.42
|
| Rate for Payer: PHCS Commercial |
$30,922.32
|
| Rate for Payer: United Healthcare All Payer |
$28,345.46
|
|
|
TRI TS FEMUR SZ 7 LEFT
|
Facility
|
OP
|
$28,900.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,670.19 |
| Max. Negotiated Rate |
$27,744.60 |
| Rate for Payer: Aetna Commercial |
$22,253.48
|
| Rate for Payer: Anthem Medicaid |
$9,938.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,542.48
|
| Rate for Payer: Cash Price |
$14,450.31
|
| Rate for Payer: Cigna Commercial |
$23,987.51
|
| Rate for Payer: First Health Commercial |
$27,455.59
|
| Rate for Payer: Humana Commercial |
$24,565.53
|
| Rate for Payer: Humana KY Medicaid |
$9,938.92
|
| Rate for Payer: Kentucky WC Medicaid |
$10,040.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,698.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,328.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,670.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,138.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,432.55
|
| Rate for Payer: Ohio Health Group HMO |
$21,675.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,120.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,143.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,941.43
|
| Rate for Payer: PHCS Commercial |
$27,744.60
|
| Rate for Payer: United Healthcare All Payer |
$25,432.55
|
|
|
TRI TS FEMUR SZ 7 LEFT
|
Facility
|
IP
|
$28,900.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,670.19 |
| Max. Negotiated Rate |
$27,744.60 |
| Rate for Payer: Aetna Commercial |
$22,253.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,542.48
|
| Rate for Payer: Cash Price |
$14,450.31
|
| Rate for Payer: Cigna Commercial |
$23,987.51
|
| Rate for Payer: First Health Commercial |
$27,455.59
|
| Rate for Payer: Humana Commercial |
$24,565.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,698.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,328.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,670.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,432.55
|
| Rate for Payer: Ohio Health Group HMO |
$21,675.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,120.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,143.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,941.43
|
| Rate for Payer: PHCS Commercial |
$27,744.60
|
| Rate for Payer: United Healthcare All Payer |
$25,432.55
|
|
